Truth Telling?!


Question: The standard of professional candour with patients has undergone a significant change over the past 30 years. Healthcare professionals are increasingly expected to communicate information to patients that is not immediately related to treatment decisions.

The purpose of truth telling is not simply about enabling patients to make informed choices about health care and other aspects of their lives but to inform them about their situation.

Truth telling fosters trust in the health care professionals and is based on the respect owed to patients as persons.

Do patients want to know the truth about their condition?
How much do patients need to be told?
What if the truth could be harmful?
What if the patients family ask to withhold the truth from the patient?
Is it justifiable to withhold the truth from a patient?
What about patients with different religious and cultural beliefs?
Is it justifiable to decieve a patient with placebo or to administer drugs covertly?

Your views?


Answers: The standard of professional candour with patients has undergone a significant change over the past 30 years. Healthcare professionals are increasingly expected to communicate information to patients that is not immediately related to treatment decisions.

The purpose of truth telling is not simply about enabling patients to make informed choices about health care and other aspects of their lives but to inform them about their situation.

Truth telling fosters trust in the health care professionals and is based on the respect owed to patients as persons.

Do patients want to know the truth about their condition?
How much do patients need to be told?
What if the truth could be harmful?
What if the patients family ask to withhold the truth from the patient?
Is it justifiable to withhold the truth from a patient?
What about patients with different religious and cultural beliefs?
Is it justifiable to decieve a patient with placebo or to administer drugs covertly?

Your views?

I will tackle your questions in order.
1. Most patients do want to know. Some don't. Up to you to ask each patient whether they want 100% of the facts or the summary version. Document their answer.
2.How much do patients need to be told. It's the same as with kids and sex education. You will see by the glazed eyes when you are giving either too much information (or the right amount of information but in the wrong language). There is one minimum standard: if the condition requires the patient to do things (e.g. take tablets, have blood tests) then you need to give the rationale sufficiently persuasively to get them to do those things. Obviously what is persuasive to one person is different from the next person. So you have to get to know your patient. Communication is by definition a two-way process. However, your question suggests you think that it is about the doctor pouring information into an empty vessel, the patient. There are so-called 'patient factors' in all exchanges. It is after all the patient's illness, the patient's livelihood, the patient's life itself that you are dealing with as a minor or moderate influence. See, it's actually about the patient.
3. What if the truth could be harmful? I assume you mean harmful to the patient, although I could be wrong. Let's say you have a patient with borderline personality disorder and they have, say, breast cancer with liver metastases on diagnosis. Hard yards! Give the truth and set up adequate support mechanisms for her. Don't hide the truth just because it's too hard to set up that support.
4. What if the patient's family ask to withhold the truth? What if they ask you to prescribe antibiotics for a viral infection? You wouldn't do the latter, so don't do the former. The family does not always act in the best interests of the patient, but you have to. Frankly this question is a no-brainer and I wonder why I am bothering to answer it.
5. Patients with different religious/cultural beliefs (I would add "and practices"). Once again you have to ask them. Or at least be aware that anything you recommend could cross cultural boundaries and be prepared to ask them if you suspect that something won't work culturally. Never routinely let anybody's partner in on a consultation, no matter what culture they are in.
6. All of us have deceived children with placebo. You should consult your insurer on this one. I always get a one-week placebo response when I change antidepressants, but my doctor told me to expect it. Re: administering drugs covertly, I don't know what country's laws permit this - do you want to continue practising medicine or not?

My views.
I would like to hear back from you, find out where you're coming from.
Madeleine
ps please quote (a) this answer and (b) my book if this is an assignment question.

medicine and the practice thereof used to be considered a "calling". now is is a multi billion dollar business and health care professionals will say and do anything you want so they can collect their paycheck and not get sued.

pOINTZ!!1

The big problem that I've found with truth telling is that the patient starts to think they know more than the doctor about their disease and what they need to get well, which is stupid when you consider the doctor has 13 years of schooling and however many years of practice.

I hate being lied to - simple as that. I want the truth always, I don't care how painful. I can't say that for all people, but I've had a lot of experience with people, and I will always tell them what they want to know, because they need to be told what is going on with their body as long as they are still living.

Harmful in what way? to themselves? like they could go off on a rampage? I don't know, if they themselves did not want to know ahead of time, I would honor that, however I don't ever want to keep something important about an actual person, from that person. In the harming aspect though, I guess that's what sedatives are for. (I've always hated the idea of restraints)
What about religious beliefs? Does it matter? What ever they wish, as long as it is within reason, as long as it is not harming or disregarding anyone elses culture, someone's religion shouldn't ever play a part in a deciding factor.

You wouldn't decieve a patient, because theoretically they would know they would be apart of a volunteer drug test. People who volunteer for human trials know that there is a section of people who get the drug, and those who get the placebo. It isn't the safest or most convienent test procedure, but it's one that has helped in the physically and psychologically ill field.

Working in healthcare myself I tend to tell my patients the truth about there condition.I look at is I wouldn't want to be lied to or have anything sugar coated.Patients should be told everything as it pertains to there condition.It depends on the person and family if I would withhold the truth.I work with the elderly and sometimes it is for the better.As far as religious beliefs I have to follow the patients beliefs regardless if I believe in it or not.I don't think its right to give a pt a placebo.Do you?

For someone who comes in wanting a pare of glasses , and shows signs of not being able to see,, but also able to read the fine print just fine , give them the glasses they came for , try the non perscription first , no need to alarm them about the dangers of perscription glasses at this time , if their sight improves , bravough ,,, if they seem to still have difficulty with vision , perhaps you should start thinking about letting them know about the dangers that come with perscription glasses ,,,,





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